Supervisor Outpatient Clinical Documentation Integrity

Lehigh Valley Health Network

1d • Remote

About The Position

Lehigh Valley Health Network (LVHN) is a nationally recognized, forward-thinking health network, ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years and a five-time Magnet(tm) Hospital for nursing excellence. Several of its hospitals received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020. LVHN is the region’s largest employer and health care provider, with nearly 20,000 health care professionals driven by a mission to heal, comfort, and care. The organization is certified as a Great Place to Work® and values Compassion, Integrity, Collaboration, and Excellence. This Supervisor position oversees the daily operations of the RA Coding Team across a multi-facility, integrated healthcare delivery system. The role involves supervising workflow, scheduling, and LVHN provider education efforts related to physician-based and ambulatory service documentation and coding, clinical quality measures, value-based reporting, and risk adjustment coding principles.

Requirements

• Specialized Diploma, CPC, CCS, or CRC with exceptional relevant background experience OR Associate’s Degree, RN or RHIT with exceptional relevant background experience OR Bachelor’s Degree, BSN or RHIA with exceptional relevant background experience OR Master’s Degree, advanced degree Registered Nurse, Nurse Practitioner or Physician Assistant.
• 5 years recent advanced clinical or risk adjustment coding experience and extensive knowledge of complex disease processes in an acute care hospital setting OR 2 years Clinical Documentation Specialist (CDS) experience.
• Knowledge of ICD-10-CM/PCS, CPT/HCPCS, modifier assignment, principles of risk adjustment, and severity of illness scoring.
• Ability to establish and maintain strong verbal and written communication with executive leadership and clinicians.
• Excellent observation skills, analytical thinking, problem solving, and excellent verbal and written communication.
• MS Office proficient and experience with electronic medical record systems.
• CRC - Certified Risk Adjustment Coder - State of Pennsylvania Upon Hire OR CCDS-Cert Clinical Documentation Spec ACDIS - State of Pennsylvania Upon Hire OR CDIP-Clin Documentation Improvement Prof CCHIIM - State of Pennsylvania Upon Hire.

Nice To Haves

• Previous leadership and auditing experience.
• Experience with data analytics.
• Experience with acute care coding, clinical documentation improvement, utilization management, billing, auditing various healthcare payers and knowledge of DRG classification system strongly preferred.

Responsibilities

• Monitors daily operations to ensure the completeness of the medical record and compliance in coding, quality, and risk adjustment for physician-based and ambulatory services.
• Ensures departmental operations align with network initiatives and departmental goals.
• Incorporates performance and process improvement tools, resources, and processes for optimal efficiency, effectiveness, and responsiveness to changes in guidelines.
• Analyzes coding trends/issues and provides recommendations for process changes to improve RA CDI and coding workflow and outcomes.
• Leads and supervises daily workflow to ensure adequate coverage and staffing.
• Participates in hiring, onboarding, and ongoing evaluation of performance.
• Tracks and trends performance data for team members, provider compliance, and abstraction outcomes.
• Produces reporting and analytics and presents to leadership.
• Promotes accountability at all staff levels through coaching, training and education, performance monitoring, consistent feedback, commendations, and disciplinary action plans.
• Ensures that knowledge of risk adjustment models, pro fee coding guidelines, regulatory requirements, and additional relevant rules remain current as changes occur.
• Ensures compliance of all provider notifications, queries, and communication per AHIMA guidelines.
• Provides education and resources to RA coding team to ensure they are up to date with all relevant information as applicable to their role.
• Facilitates and directs provider and RA coding team education efforts for risk adjustment.
• Works with RA educator specialist to develop effective education content related to coding/billing, HCC, and risk adjustment concepts.
• Ensures education specialist is providing accurate and up to date education content to providers, coders, and CDI team in effective and appropriate venues.
• Serves as a resource for colleagues, physicians, and as liaison to internal departments and external customers.
• Collaborates with colleagues across the network and acts as HCC RA model, pro-fee coding, and clinical data core measure subject matter expert to disseminate outcomes and education.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree